Alternative Ways to Assist Pain and Help with Pain Management

After my recent posts of the management of pain, pain medications and how pain affects so many people lives daily, it is pretty clear that there are lots of people out there in pain. Worst still it highlights what I have known for many years, is that many people who are in pain, or have inflammatory pain conditions, are not being managed really well. Unfortunately many are also trying to manage their own pain conditions and may even be dependent on pain medications. Some of these medications taken long term may in fact be exacerbating their current symptoms, or actually making their pain and inflammation worse. Some of the medications may in fact by shutting off the body’s ability to know that it isn’t actually in pain anymore, but the body actually thinks it is. It is such vicious never ending cycle for many people and there seems to be no long-term, or short term, solutions for many who have to endure the physical and emotional consequences of all these things combined.

The one thing for sure, is that pain often isn’t managed well and there need to be more done to help those in pain. But, it also requires those in pain to seek proper help too. Again it is a bit of complex issue and many in pain often get dismissed initially as well, or are looked at as people who are dependent on pain medications just seeking more pain meds.

Pain does need proper management and if pain is not managed properly, it can do more damage than the medications health professionals, and the person in pain, are worrying about. But sometimes the blanket pain medication treatments don’t work, or they just aren’t enough, and this is why when it comes to pain, it need to be managed with a multi-modality approach. It really cannot just be all about taking medication, or telling people to just go and learn to live with their pain and all will be OK. It won’t be OK and we need to start to educate all concerned that there other options that may assist the current medical treatments and management strategies.

Let’s look at some of the alternatives to pain medications and how these things can help assist those in pain and can be used alongside medications to give better control of pain and also help in reducing dependency of pain medications.

1.Watch your diet

Eating the right foods may provide some protection from the symptoms of pain and the disease state that you may have. The role of diet in inflammatory conditions has been investigated in recent years due to the influence of diet on some of the processes linked to certain disease states that are causing pain and inflammation on a daily basis. Many of the so called anti-inflammatory diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all.

People in pain need to adopt an anti-inflammatory (grain free, primal, ketogenic style diet) to assist with settling any inflammation in the body and also helping the immune system.  This also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health.  Regulation and restoration of gut function and the microbiome is so important and assisting with pain and inflammatory conditions.

Excess bad carbohydrates increase insulin response and this then causes the body to store fats and stops the burning of fat. This also leads to inflammatory conditions and more inflammation in the body. Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. Excess fat and excess weight all lead to inflammation and stress on the body and this can also exacerbate pain and pain pathway.

Certain environmental estrogens, known as endocrine disruptors,  such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating pain and creating inflammation in the body too

2.Try complementary medicine and complementary therapies

Many people with pain and inflammatory disease states find symptom relief from using a range of different complementary and alternative medicines. There is some good solid research to show that certain natural medicines may help with the management of pain and inflammatory disease states and the associated symptoms. There is now some good research to support many natural medicines treatments such as Acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, Yoga, Pilates and more.

Out of all the natural medicine therapies, Acupuncture and Chinese medicines has been one of the most researched and have shown to be the most beneficial and to assist those suffering pain and chronic inflammatory disease and their associated symptoms. Acupuncture has been widely researched to assist with many pain conditions and is now even used in some emergency departments around the world, for acute and chronic pain. Chinese herbal medicines have been used for centuries for pain and inflammatory disease and modern research has shown that certain Chinese herbs and herbal medicine formulas may assist with pain and painful conditions.

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of some pain conditions. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though. Correction of the microbiome, but using pre and probiotics may assist in reduction of inflammation in the body and thus assist with pain and painful disease states.

There are also western herbal medicines and naturopathic herbal formulations that can assist with pain and assist with pain management. There are also certain amino acids and nutritional medicine supplements that have been shown to assist with managing pain and inflammatory conditions. Like any conditions, management need to be done on an individualised approach and what works for one person, may not work for another.

Chiropractic and Osteopathy have been used for centuries to assist with pain and pain conditions. By correction of the sublaxations and correction of posture, this can assist in better nerve functioning, better blood flow to muscles and also help with pain reduction and reducing inflammation.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in pain management. Just like in the medical model, this can also be hard to find. Please find someone who is a registered healthcare practitioner, or part of an association for qualified healthcare practitioners.

3.Boost intake of omega-3 fatty acids

The is lots of research on the health benefits of taking Omega 3 fatty acids and a diet high in these healthy fats. Omega 3 fatty acids may assist many inflammatory conditions such as depression, cardiovascular disease, arthritic conditions and many conditions where inflammatory processes are then leading to pain.

Researchers have also found that the type of fat included in your diet makes a difference in your risk factors for inflammation and pain conditions. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of inflammatory disease by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of inflammatory conditions by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for pain and inflammatory conditions. Another way to get Omega 3 fatty acids is through supplementation, but please make sure you are using a practitioner only grade omega 3 supplement to ensure higher potency and better quality control.  Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training may assist in helping to reduce the reducing the symptoms of pain and reducing inflammation in the body.

While resistance training and high intensity interval training may assist in pain management and reducing inflammation in the body, some of the more gentle forms of exercise, such as Yoga and Pilates, may also assist in reducing pain and inflammatory response in the body too. Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.There has been lots of research into the benefits of Yoga and Pilates and how it can assist pain and inflammation.

No matter what exercise, you choose, exercise may help those with pain and inflammation in many ways, including:

  • encouraging the circulation of blood to your organs
  • maintaining nutrients and oxygen flow to all your body systems
  • assist with decreasing pain and inflammatory response
  • assist with reducing stress
  • releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Research has shown that those who engage in some sort of regular exercise have fewer symptoms of pain and less inflammation that those people who do not participate in regular exercise.

5.Managing Stress Levels

Stress and emotional factors are probably one of the most under rated causes of pain and inflammatory response. Stress and emotional factors are big factors in any disease and can make any disease worse. Not only can stress and emotional disorders be exacerbated by pain and inflammation, but so can pain and inflammatory symptoms be exacerbated by stress and emotional disorders, in a never-ending cycle. Pain and inflammation could contribute to making your stress levels, or emotion issues worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques may all assist in reducing stress and emotional disturbances that exacerbates inflammation and pain pathways and painful conditions.

People with pain and chronic pain and inflammation need to manage stress by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.TENS and Neuromodulators

Transcutaneous electrical nerve stimulation (TENS) is an inexpensive nonpharmacological intervention used in the treatment of acute and chronic pain conditions. These small battery-powered devices deliver alternating current via cutaneous electrodes positioned near the painful area. The parameters of pulse frequency, and pulse intensity are adjustable and linked to TENS efficacy. TENS activates a complex neuronal network to result in a reduction in pain

Neuromodulation is the process by which nervous activity is regulated by way of controlling the physiological levels of several classes of neurotransmitters. Many pain management specialist now use a common form of neuromodulation involves using a device to deliver electrical current in therapeutic doses to the spinal cord to disrupt pain signals from the spinal cord to the brain, converting them to a more pleasant tingling sensation. This has been proven a safe and effective therapeutic approach for managing chronic pain of the arms and legs, neck and back often after spine surgery, or for other neuropathic conditions.

In Summary

It is important to know that people with pain and disease states that are causing chronic pain, will need a multi-modality, or team approach to deal with this disease. The team you need and modalities that you will need will be dependent on your individual symptoms. This will mean finding practitioners who will listen to you and also be open to trying some of the alternatives to some of the pain medications and opiates alongside pharmaceutical medications. As I said before, these alternatives may assist in treating your pain and managing your pain long term and also help with reducing some of the pain medications you may have been dependent on. Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who specialise in the disease you are suffering from too. Again, the approach that you and your pain management specialist, or healthcare provider, choose to take will vary depending on your signs and symptoms.

Before starting any pain management, or new treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are specialists in your condition and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are specialists in this area of medicine. Too many people are missed and dismissed purely because they are just seeing the wrong people in the first place.

Lastly, if you are in pain and have a pain condition, please do not try and keep managing it yourself, or try to self-medicate. You need to be managed properly and should be getting the advice of a professional, not your friends, family or social media buddies. Pain needs to be managed and it needs to be managed properly and this also goes for pain medications as well. If you are still in pain and pain symptoms are getting worse, this means that you need to get something done about it because your disease may in fact be getting worse, or your body may not be responding to medication any longer.

Take care

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-No Stone Left Unturned

 

Lets Talk About Pain, Pain Medication, Dependency, Detox & Withdrawal Symptoms

Recently I did a post on over the counter pain medicines and how that as of February 2018, that some of these codeine based pain medicines, will now no longer be available over the counter in Australia. I know that in other parts of the world, these medications are not available over the counter anyway and in some countries even paracetamol is not available as readily as it is here in Australia.

The post surely did get people talking and it surely highlighted some very important points. It also highlighted how many people are in pain daily and something that I have known for a long time. I actually know that pain and people with pain conditions, aren’t managed very well. It also highlighted that many people are self managing pain conditions and that many do not realise that they in fact dependent on medications, alcohol and other drugs. Many also do not realise that the pain and symptoms they are experiencing daily, may in fact be withdrawal and dependence symptoms from their medications and substances they are using, including alcohol, and may have nothing to do with their condition at all. It is a very complex issue and there needs to be more education around this very sensitive issue.

Now, before we get started and before anyone tries to bring the personal/emotional side of things into this, I need to be very clear on this and set some boundaries up front. I need everyone to listen to this, so it is clear and that what I am about to say is coming from personal experience, clinical experience and someone who cares and is just trying to help with the right advice and right education around this issues.

So before we start I need to get a few things straight

  1. I have lived with a painful condition and have used pain medication and been dependent on pain medications. I have also withdrawn off pain medications
  2. I have loved ones who have pain conditions, who suffer daily and have also used pain medications to get through their day. Also know many of these have learned to manage and overcome their disease and pain too.
  3. People in pain, need help to get out of pain and pain medications are one way of doing this
  4. Many people who are in pain are actually dependent on pain medications and are completely unaware that they are dependent
  5. It is completely OK to take pain medication when someone is in pain. It just needs to be monitored a little better than it has been in the past.
  6. Please take the personal out of this and just sit back and listen
  7. I am not here to judge, or attack anyone
  8. This post is purely from heart, from caring and also about helping people with education so that they can get help if they need to
  9. The first part of any change and getting help is admitting you have an issue, or a problem, in the first place.
  10. The is no guilt, shame, or anything wrong with admitting you have a problem, or a dependency
  11. For the sake of this post I am going to used the word “Dependency”, rather than the words “Abuse” or “Addict”
  12. Perception is reality and sometimes ones perception is not reality, or based on all the facts
  13. Not all pain is from the withdrawal of medications either, but some of it could be.
  14. We are here to support people and care for people, not attack them. Anyone found attacking another on any posts surrounding this subject, will be deleted.
  15. Lastly, to get help, you need to see a qualified healthcare practitioner and you should only ever rely on information from a qualified health expert, not from your friends, your support groups, or anyone without a proper qualification in things to do with medical, medicines, or health conditions.

Right, now we have set the boundaries and we are clear, we can move forward and I can start explaining about pain, pain medications, pain pathways and also withdrawal symptoms

Before I start, I need everyone to open, his or her, minds a bit and think of how you feel when you have had some alcohol. Let’s not forget that alcohol is a drug and it can make you feel good initially and then not so good if you have a few glasses, or more. You can also become dependent on it too, and yes, it can be abused.

So, say you have a few glasses of alcohol, how do you feel while you are consuming it and shortly after?

This is for the average person, but most people would feel a little warm and tingling and feel quite good wouldn’t they?

But, even with a few glasses, would you necessarily wake up OK the next morning?

Some people might wake up semi OK, some might feel a little less than OK?

For some, a few are nothing because they are used to having way more. Some of these people may in fact be dependent and actually have an alcohol dependency.

So, say you have more than a few glasses of alcohol, how might you feel the next morning?

More than likely you may feel a little dusty, or for some, you may in fact have what we all know to be a hangover… is that correct?

You might feel really tired, irritable, nauseas, sore, have a headache, or a really bad head that feels like it might explode, and all the senses are just a little on hyper-drive and you would feel a little off??

Now that we are clear that alcohol can give you a hangover and make you a bit sick and that alcohol is in fact a drug, let me ask you this?

If alcohol is a drug and it can give you a hangover, even after one night of taking it, and taking just a few glasses of it, then why would not a medication, that can produce all the initial effects of alcohol, then not cause you a “Hangover Effect” the next day as well????

Just have a think about that for one second and let it really sink in.

Hmmmm, what are you thinking now?

Well, I am sure this is where we get some people going “But, but, but!”

Well there are no “But’s”. This is the hard but honest truth. Any drug, being prescription, over the counter, off the street and illegal, can cause you a withdrawal and hangover effect. Also, the longer you take those drugs, the more you take them etc, the more you need to take and the more dependent you become on them. This doesn’t mean I don’t get why people take these medications. I do get it and I get all the reasons behind it too. This is just to explain everything logically and properly to people so that they also get that they may not be managed properly and that they may also be dependent on medications, which are actually in the long term, making all their symptoms worse, or actually causing the ones they have now.

Just so people don’t forget, please go back to points 1 and point 2 in the ground rules I set before. I have lived with pain and I have loved ones who are in pain and yes, I have taken pain medications and so have my loved ones.

Ok, so we are now all on the same page and are clear here, yes, many of the medications that people are taking daily, or periodically, or once off, or chugging down by the packet load, or are actually causing them rebound symptoms and withdrawal symptoms, when those drugs wear off.

We also need to recognise that some people are only taking medications every so often, when they need them too and this is more for people who are medication daily, or frequently. But even still, people do need to be away of rebound symptoms from taking medications, even periodically.

When we talk about “withdrawal” and “rebound symptoms”, let’s all go back to the alcohol story. We know that the hangover symptoms occur because of a rebound and withdrawal affect from the alcohol messing with the symptom, causing dehydration, causing inflammation and then causing all manner of symptoms from nausea, headaches, tiredness and even muscle and joint pain. The same goes for when you take any pain medications, especially those that are opiates, or contain codeine, or convert to morphine in the body.

Are we all getting this yet??

Right, then lets move on.

Now, the longer you take a medication the more your body gets used to it and the more that you may have to take to get that same therapeutic affect on the body and the pain that you are trying to manage. But, the more you have to take, the more dependent you become on that medication and the more worse you are going to feel when the medication wears off and tries to leave the body. Then it is going to take longer to ween off the medication, when you finally realise that you are dependent and that you need to so something about it. That is if you have that realisation, or finally admit there may be an issue.

One of the things that I have mentioned many times before, is that sometimes the body has been in pain that long, that the body doesn’t realise that it isn’t in pain any longer, that you also need to turn that response off, because it has actually become a habit, rather than the body actually still being in pain. The other issue is that the pain medications may in fact now be what are causing the pain, through rebound symptoms and withdrawal.  This one is a bit tricky to explain to people, but in essence what we need to do is actually tell the body it isn’t in pain any longer, so that it switches off that response in the brain. To do that we need to detox an individual and then see what pain really does exist still and then manage those remaining symptoms. I will talk about proper medical detox further in the post.

Now let’s look at how pain medications, opiates and some elicit drugs work

Pain medications, Opiates and other pain relieving drugs, all change the way the brain responds to pain and they can also produce a “high” feeling by disrupting the reward and pleasure centres in the brain. This is why they can make you feel a bit stoned, or a bit light headed and why you should not drive, or operate machinery etc, while you are taking them. They can dehydrate and constipate you too, so this is why you should only take as directed and also make sure you drink enough water, take some electrolytes and take it easy too. Let’s not forget the serious side effects of medications that can put overload on your liver and other vital organs and actually shut them down, if taken for long enough, or in a super high dose.

The central nervous system, which includes the brain, cardiovascular and respiratory systems, has opioid and pain medication receptors that receive opiate drugs and other pain medications, and these drugs bring a variety of physical and emotional effects. Your heart rate, respiration, blood pressure, and body temperature are usually all lowered while pleasant feelings are increased. It can cause the opposite effect too, where some people get hyper-activated responses too.

Repeated use, or abuse, of pain medications, or an opioid drug, can actually change the way an individual’s brain chemistry works and then lead to physical and psychological dependence. The body may not feel “normal” anymore without the drug’s interaction, and withdrawal symptoms may start in between doses or when an individual stops taking the pain medication, or drug they are on.

What Are Pain Medication, Drugs and Opiate Withdrawal Symptoms?

Certain over the counter medications (such as codeine based meds), prescription painkillers, Opiates and heroin, can produce withdrawal symptoms just hours after the last dose, and the symptoms can last for a week or more. Sometimes these symptoms can be minor, but many times they can cause all manner of symptoms, which I will list below in detail. Some symptoms can be major and unassisted withdrawal may, or may not be life-threatening. When someone doesn’t withdraw properly it can also lead to relapse and further dependence on a medication, or drug. Medications and therapy, accessed in medical detox, may make relapse less likely. I’ll talk about why it is necessary to do a proper medical detox first, before seeing practitioners outside the medical detox model.

What Are Pain Medication ad Drug Dependency Symptoms?

Pain medication and drug withdrawal symptoms can last about a week, or even longer for some, and may include:

  • Irritability
  • Agitation
  • Depression
  • Muscles aches
  • Insomnia
  • Thoughts of suicide
  • Anxiety
  • Inability to concentrate
  • Diarrhea
  • Bowel Pain and Rectal Pressure
  • Severe bloating
  • Fluid Retention
  • Sweating
  • Body aches
  • Runny nose
  • Headaches
  • High blood pressure
  • Irregular heartbeat
  • Many other symptoms not mentioned here

Detox and Withdrawal Duration

Withdrawal is the collection of side effects that occur when a drug is removed from the brain and body of someone who is dependent on it, while detox is the actual removal of the drug itself.

Withdrawal symptoms can last anywhere from a couple of days to up to a week or longer. For most pain medications and prescription opiates, withdrawal symptoms take shape 8-12 hours after the last dose and it peaks in the first 72 hours. The time within the withdrawal period depends on the medication, or drug taken. This is where rebound symptoms can occur.

The first week of withdrawal is typically the worst, but some symptoms may actually last longer. Symptoms typically last up to one month, but can linger for several months. Some effects can be permanent if there is a genuine abuse of a medication. Symptoms that can last longer than one week include tiredness, muscles aches and tiredness, depression, anxiety, and trouble with sleeping.

This diagram shows the withdrawal of these medications and time frames of side effects from withdrawal after the last dose is taken.

Medical Detox

Detox may begin before withdrawal symptoms start and while the drug is still active in the body. This way the drug can be safely removed. During medical detox, individuals are monitored around the clock for 5-7 days, vital signs are continually checked, and medications may be used to control more difficult withdrawal symptoms. If an individual is heavily dependent on pain medications, opiates, or took large amounts of the drug for a long time, or has a family or personal history of addiction, medical detox may last up to 10 days. Medical detox ensures that an individual is stable before moving on with a comprehensive substance dependence treatment and management program.

Relapse after a proper detox can increase the risk for a potentially life-threatening overdose since the brain and body may not be used to the same amount of drugs that was used before. Each year around 30,000 people worldwide die each year as the result of a prescription pain reliever overdose. Each year around 500,000 people worldwide seek emergency department treatment for a reaction to the abuse, or dependency of pain medications or drugs to help with pain. By decreasing pain medication side effects and dependency on these medications as drugs, an individual may be less prone to seek out these same pain medications and drugs again after detox. Medical detox can help sustain abstinence and potentially prevent a tragic, relapse-related consequence.

While there are non-medical forms of detox, I wouldn’t recommend someone doing these until a proper medical detox is done. Proper support and around the clock care is needed in the initial stages of a proper detox and this really cannot be provided out in private practice, or by complementary medicine practitioners during this initial stage. I am all for people seeing natural medicine practitioners and using natural medicines but this needs to be done after the initial medical detox. That first phase needs 24-hour care, medicines, psychological care and so many things that would be really hard to find out in a non-medical environment. There are some specialised centres that use a multimodality approach, using medical science and complementary medicines, but these are few and not always cheap to access either.

Sure, after the initial medical side of things, go your hardest and you should be seeking natural alternatives to pain medications and looking and diet and lifestyle choices to help deal with pain. You should also be seeking alternatives to pain medications and seeking therapies that can help manage your pain, such as acupuncture, herbal medicines, pilates, yoga, counselling etc. All these things are important for ongoing care and helping deal with disease states and ongoing pain. But if you have reached the point where you are dependent on a medication, or drug, you are going to need lots of help and you will need help with proper detox first. Please, do not think that those packet over the counter detoxes from a chemist etc, are a proper detox. They are just a herbal laxative that cleans out your bowel. Always speak to a qualified professional to get proper advice about detox and microbiome restore.

Having lived with pain and having actually properly detoxed off meds years ago, it wasn’t until I was off all meds and things managed properly while detoxing, that I realised that some of my daily pain, was actually withdrawal effect of my pain meds. I don’t think many people realise that this happens and all the nausea and migraines and headaches and increased pain, is actually withdrawal. Only once pain is managed well, a proper medical detox done and then a plan put in place, do people realise how much the meds were actually part of their daily struggle and it was all withdrawal. Then you can use proper pain management strategies and alternatives for pain and also preventative strategies too.

I hope this has given you all a better insight into pain, pain medications and withdrawal symptoms and if you aren’t being managed properly for your pain and pain condition, then you need to talk to your healthcare professional about this. Everyone’s pain and pain symptoms are going to be different, even if they have the same disease state, or inflammatory condition. This is why individual treatment plans are much more effective than a treating the masses approach.

I’ll do a separate post of some alternative to pain medications and drugs shortly, as it is whole post in itself. I will be collaborating with integrative medicine practitioner and mindfulness expert Rosa Bunn on this topic. 

In the meantime have a read of my post about me knowing what it is like to live with pain

http://drandreworr.com.au/knowing-all-too-well-what-it-is-like-to-live-with-pain/

I have written quite a few articles on pain and pain management and I urge you all to have a read of them all, so that it gives you some understanding of where I am coming from and also some helpful pain management strategies

  1. http://drandreworr.com.au/getting-a-handle-on-pain-with-proper-pain-management/
  2. http://drandreworr.com.au/stop-telling-women-that-period-pain-is-normal/
  3. http://drandreworr.com.au/early-intervention-early-management-is-vital-for-gynaecological-conditions-menstrual-issues/
  4. http://drandreworr.com.au/period-pain-is-not-normal-and-doctors-in-australia-and-the-rest-of-the-world-need-to-start-listening/
  5. http://drandreworr.com.au/asking-the-right-questions-about-period-pain-gynaecological-issues/
  6. https://www.sciencedaily.com/releases/2017/06/170618103517.htm
  7. https://www.medicalnewstoday.com/articles/318532.php

Take care and if you do need help with pain and pain management and getting of pain medications, you can always come and see me and book in a proper consultation and I can help you and point you in the right direction too. Sometimes we all need a little help in the right direction and sometimes the first step is admitting you have a problem in the first place. Oh, yes, I also get that many of you have been missed and dismissed also and this is why you are where you are now.

Telling it how it is and keeping it real. I get it and I understand.

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-No Stone Left Unturned

Getting a handle on pain with proper pain management

One of the things that I see not managed very well is pain. I think much of this comes around a perception that we should be able to manage pain with over the counter medications and some of it is also not really knowing what to do, if what we are doing for ourselves, or are currently doing, isn’t working. Some of it is also that healthcare practitioners aren’t managing it well either.

Now, before I start talking about pain, and so that people understand where I am coming from, I need for people to know one thing.  Everyone’s pain levels are different and everyone’s cause of pain is different too. I also know what it is like to live with pain daily and manage a chronic condition that causes pain and affects one’s life. So I understand pain and understand it well and I sympathise with anyone who is in pain. So I just ask for people to take the personal out of this, just listen and hear what I am going to say. Again I have lived with chronic and acute pain daily and I know what it is like and I have loved ones who have to manage it daily as well. So what I am about to talk about is coming from a place of caring, wanting to help and also knowing how to manage pain on a clinical level as a healthcare professional.

Every day I see people posting in closed groups asking for help with pain and things they can do to manage pain. It breaks my heart hearing what some people put up with, or if I see they aren’t being told the right thing, or managed properly. Often I see people putting up with pain because they fear going to the hospital, seeing their specialist, seeing someone else,  or that they should be able to handle it themselves.

No matter what, constant and acute pain is not good for the body and it also means that there is something wrong and it needs to be attended to.

The thing is, pain needs to be managed, just like any other health issue, and if it isn’t managed, or managed well, then it can really affect ones physical and emotional wellbeing. I know people will say that long term medication isn’t good, and it isn’t, but long term unmanaged pain can be far more detrimental than any long term medication. It truly is a catch 22 situation.

When pain gets to a point where over the counter medications aren’t working, or even some prescription medications aren’t working, then something needs to be done about it. This either means surgical intervention, or it means that you need stronger medications and you need this in the form of proper medical management of that pain. It may also mean other therapies and treatments outside of what you are currently using and being managed with.

Many times when I hear that people are in pain, one of the things that stops them doing anything is that they perceive that nobody is going to help them because what they themselves have tried, hasn’t worked. I wish I could get it through to people in pain, that the best thing they can do is go and get the pain managed properly. This often means a trip to the nearest hospitals emergency department and I think this is where people then talk themselves out of it. It is always better to go and be managed properly, than sit at home still in pain.

When people come to see me and then I have to refer them for surgery, one of the things I always talk about and have an action plan for is pain management. I always tell my patients to properly manage pain after surgery and even do precautionary pain management post-surgery. I always give my patients a handout and action plan for pain management, whether they need it or not.  After surgery there is often a bit of illusion state around pain, because there have been anaesthetics used and other heavy duty sedatives. So often people wake up in recovery and think the pain isn’t as bad as it is, because it is being masked from the anaesthetics. Then they go home and don’t bother to keep up their pain meds and then the pain kicks in and then it is really hard to get back on top of it again once it starts. Once the pain cascade starts, then it is really hard to then try and get back on top of that pain yourself. This is why it is always good to take precautionary pain medications for a few days (or longer) post-surgery and then taper them down and start using some other alternatives to manage the pain. I’ll discuss some great alternatives for pain management later on, but for now, let’s just talk about the medical and pharmaceutical options.

The basic same principles also apply to people who have flare ups with pain, or have chronic, or acute pain. It needs to be managed and it needs to be managed as soon as possible. The longer you are suffering in pain, the harder it is to treat and get under control. Sure, try all the conservative treatments for pain such as over the counter medications, herbal medicines, acupuncture, yoga, meditation etc, but if those aren’t working well enough, or aren’t working at all, it is time for medical intervention. The same goes in reverse too.

Sometimes the body has been in pain that long, that you also need to turn that response off, because it has actually become a habit, rather than the body actually still being in pain. This one is a bit tricky to explain to people, but in essence what we need to do is actually tell the body it isn’t in pain any longer, so that it switches off that response in the brain.

Getting back to acute pain, and when pain is getting out of control, this is where I need people to listen. Many times I see people posting in groups, telling their support group and that they are in pain and saying things like that they feel it would be pointless to go to the hospital, as they usually do nothing to fix their issue. The thing is sure, emergency departments aren’t there to fix chronic conditions, but, they are there to help you get out of pain, or patch you up, and then refer you on for appropriate management if need be.

Now, before I talk about this next bit, if you are in acute pain and do not know what it is from, you need to go and get that pain looked and get it under control. You can either consult with your healthcare provider (GP etc), or go to your nearest Emergency centre.

Speaking about emergency centres and hospitals, I need to let people know that there is no shame in going to these places to get your pain managed properly. I also need people to know that emergency centres (A&E) are not there to fix your long term issue. They are there to assess imminent danger, control pain etc and then patch you up and refer you on to other specialists in the field of what your particular issues is. That is it. All too often people do have a perception that if they turn up to emergency department, their long term health issue is going to be fixed. That is not their job. Again they are there to assess danger, control pain, stop your dying (if that is needed), then refer you on for appropriate management. Sometimes that means staying in hospital until you are stabilised. All too often I hear people saying that they went to emergency and they did nothing. Well, I doubt they did nothing. They would have assessed you, medicated you and if your condition isn’t life threatening, you would most probably be sent home. That is what they do.

This gets me back to those in pain and are trying to talk themselves out of going to hospital, because apparently, through past experience, or someone has wrongly told them, that they won’t be able to help you. This is wrong. If you are in pain you are best  going to emergency, where trained people, not our untrained internet buddies, can assess you properly and then help you with pain and stabilise you.  If all emergency do is control your acute pain and make sure you aren’t dying and are stable, then they have done their job. Controlling someone’s pain can actually stabilise the body in more ways than one. Once that pain is stabilised, then what you need to do is ask them for medications to be continued to actually help with the pain cycle. You can also continue on with previously prescribed medications to control that pain, now that stronger medications have been administered and your pain levels have lowered. This then buys you time to see your regular healthcare provider as soon as possible and talk about a better pain management plan. If that said provider isn’t managing you properly, then you need to get a second, or third, or tenth opinion. Look, every profession has people who are not good at their job and some healthcare professional are crap at things like pain management. So find someone who can help you with ongoing pain management. If you can’t find someone, then message me for details of someone who can.

There are now also some pain modulators (neuro-modulators) and implants that are being used to control pain too. People are also getting great results with botox and other injectables.

Last but not least, sometimes you need to look outside the medical model, for help with pain. Actually I believe it is essential. Sure, get your acute pain managed with medical intervention, but you may also need to look at complementary medicines for ongoing pain management, especially chronic long term pain. No medicine has all the answers, so this is why I am very passionate about people using a multimodality approach to their health issues and especially for pain management. I always say to people that if what you were doing currently is helping, then you wouldn’t be in pain and if you are still in pain, it means you need to change something, or look at other ways to manage it. Unfortunately while modern medicine saves lives and can help us in so many ways, it doesn’t have all the answers either.

Non-Medical Ways to Manage Pain

One of the best non-medical ways to control and manage long term pain is Acupuncture and Traditional Chinese medicine (TCM). This medicine has been around much longer than modern medicine and it is very effective. There is now research to show that Acupuncture and TCM is not only an effective treatment for pain and pain management, but it is also equivalent to the effects of some of our strong pain medications, when it is administered properly by a trained healthcare provider and with a series of treatments. It is also being used in mainstream hospitals for pain management too. While acupuncture is very effective for pain, there is no such thing as a one off treatment for any medicine and we all need to remember that.

There is also an amazing therapy called Biomesotherapy, also known as biopuncture. It combines the use of acupuncture and also uses injectable saline and anti-inflammatories into the acupuncture points. Local anaesthetics and pharmaceutical injectable pain killers can also be injected into the acupuncture points and this is how it has been used in part of Europe for over 50 years by main stream medicine. It is such an amazing therapy for acute pain.

There are also Chinese herbal formulas that can assist with pain and pain management and they also help with the root cause of your pain as well. Again these aren’t a one off treatment and require a course of treatment to get the true benefits. You don’t just take one antibiotic, or one pain medicine and it fixes your issue and the same goes for herbal medicines. What we also need to remember is that up to 50% of our pharmaceuticals are actually derived from herbal compounds.

There are also some other great complementary therapies that can help pain. Chiropractic and Osteopathy can help with skeletal pain and also help with realigning sublaxations that are impinging on nerves and causing pain. Both modalities can help balance the body as a whole.

Yoga and Pilates can help with pain by rebalancing the body, working on the core and also by assisting the body to relax. There is a bit more to it than that, but they can help

Massage can also help with pain and pain management.  There are also other herbal medicines that can help too. Your healthcare provider, or herbalist, can assist you by consulting with you and helping manage your condition. Just like medical interventions and pharmaceuticals, you should never self-prescribe and always consult with someone who is qualified in their particular profession. They can also administer you practitioner only medicines that are far stronger and more clinically efficient that over the counter products. It is the same in modern medicine too.

Physiotherapy can help with pain management and rehabilitation and women with pelvic pain may need a physiotherapist that can help with pelvic floor physiotherapy and that can do work internally. This is a specialist area though.

Pulse magnetic therapy and TENS (Transcutaneous Electro Neuro Stimulator)can definitely help with pain and ongoing pain management. While many people have heard of TENS, not many have heard of Pulse Magnetic Therapy and this is something that I have been using for a long time and had great results with for chronic pain (all forms of pain) and also pelvic floor instability and incontinence. It really works.

Let’s not forget the power of a healthy diet, when it comes to pain. Diets high in processed foods and sugars and refined grains, alcohol etc promote inflammation. Then inflammation causes pain and can make conditions causing pain worse. I always assess people diets, when they have pain, or health issues.

Lastly, talk therapy and counselling and mindfulness training is probably some of the most underrated therapies for the ongoing management of pain. I can’t say this enough. Our brain is what controls all our senses and unless we learn to control stress and quieting our mind, then managing pain is so much harder. I also know it can be a catch 22 situation too, but it is needed. While support groups and talking with friends is great, it cannot compare to the help from a trained professional, who has the appropriate years of training and is specialised in their particular field, or profession.

Oh, and please don’t get your medical advice from people on support groups either. I see this so often and it really scares me what I see and hear.  I know they are well meaning and their support is great for you, but they are a trained professional it could be very dangerous and let’s not forget that everyone has different needs according to their condition. What medication, or therapy,one person is on,or taking, may make another ill, or actually make someone else worse. Please do not Dr Google either. A degree in Dr Google, doesn’t make one a healthcare expert and much of the medical advice on Dr Google is not right. Sure, be educated and be informed, but be careful too. Always consult with a healthcare professional for any health advice, or before trying to do something to manage your health.

Pain is something that we have all experienced, but it is not something that should be endured either. Of course there are individual cases that are just off the charts and require a whole different level of management. These people I feel sorry for the most. While some of these cases may never have their pain gone completely, with the right treatment most of them can be managed to some form of normalcy.

For the rest of the population, most pain can be treated if intervention is administered early enough and there is good ongoing management moving forward. The problem for many is that they aren’t being managed properly and many are trying to just do it themselves. That isn’t going to work.Some people just leave it too long too. The longer you leave pain not managed, the harder it is to treat.  You may also need that multimodality (team approach) for some conditions such as endometriosis and gynaecological conditions. Some other causes of pain will need this too. For others, they just need to see the right people and once they do, their pain can be treated, or managed really well. In many cases, it can be fixed completely.

Always remember that there is no such thing as a one off treatment for pain, or any health issues, and that there is no miracle one off pill to fix pain either. Even though pain need to be managed with medications sometimes, it isn’t always the answer either. People need look at treating the cause of their pain and also looking at other therapies outside of modern medicine too. This is where individualised treatments and treatment/management plans are the best, because everyone is different in what they are experiencing and what their particular issue is.

I have seen the amazing effects of a combination of therapies, or stand-alone therapies, in the treatment of pain and its ongoing management. If you aren’t getting the answers you need, with who you are seeing, or what you are currently doing, then you need to look outside the box, think outside the box and start finding treatments and healthcare people that can help you and your particular health issue. Never underestimate the body’s power to heal itself and never underestimate the power of a second, or tenth opinion.

If you aren’t getting the help you need, then book in a consult with me and I will do my best to get you the help and care you deserve and should be getting. I also have a great network of trusted professionals I work with if it is outside something that I do, or if you need that team approach for your condition. I have my trusted team and that is what you may need too.

One more things, for anyone, pain is the sign that something is wrong in the body and means it needs to be addressed. Oh and always remember, period pain is not normal either.

Take care

Regards

Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-Women’s & Men’s Health Advocate

-No Stone Left Unturned